EVENING. Health. Healthline. Letters

Q-It seems that there are many aspects to choosing and...

Q-It seems that there are many aspects to choosing and using a birth control pill that can make a big difference for your health. Would you discuss the pros and cons of these medications?

A. In medical talk, pros and cons are called benefits and risks. Every drug, treatment, therapy, etc., has an up side and a down side. Even using no birth control at all carries a risk-that of an unintended pregnancy.

The leading benefit of birth control pills is that they are effective at preventing pregnancy if they are taken on a regular basis and as directed. Pregnancy has health risks of its own that are much greater than the pill for most women. Except for the over-40 age group, a woman's risk of dying because of pregnancy or childbirth is greater than of dying from taking the pill.

The pill has other benefits as well. Oral contraceptives lower the risk of cancer of the endometrium and ovary, and they also appear to help prevent ovarian cysts, ectopic pregnancies, benign breast disease and pelvic inflammatory disease. They also can stabilize an irregular menstrual cycle and decrease premenstrual syndrome in some women.

The major health risk of the pill is an increased risk of cardiovascular disease, including stroke, heart attack, high blood pressure and thromboembolic disease (when a blood clot forms and stops proper blood circulation). Risk of cardiovascular disease for everyone goes up with age. This is why women over age 40 (or age 35 for women who smoke) are advised to choose a different form of birth control.

Despite the benefits, birth control pills have gotten a bad reputation. Many women believe they are very dangerous and are afraid to take them. In fact, the opposite is true. One study has shown that more women are kept out of the hospital because of reduced risk of ectopic pregnancy or ovarian and endometrial cancer.

Some of the unearned reputation comes from studies done a few years ago linking the pill to breast cancer. These studies later were found to be wrong. There is little evidence of any link between the pill and breast cancer.

Remember, a health risk is not the same as a side effect. Side effects of oral contraceptives include fluid retention, breast tenderness and spotting between periods. Some women using the pill may become depressed or nervous. The newest versions use very low doses of hormones, and this may minimize the side effects.

Only your physician can tell you if the pill is the best form of contraception for you. A young woman who is in good health and has no other health risk can almost always take birth control pills safely.

----------

Dr. Allan Bruckheim welcomes questions from readers. Although he cannot respond to each one individually, he will answer those of general interest in his column. Write to Dr. Bruckheim in care of the Chicago Tribune, Room 400, 435 N. Michigan Ave., Chicago, Ill. 60611.